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NPI Code Detail

MEDICARE: VOLUSIA BRAIN AND SPINE LLC

MEDICARE: VOLUSIA BRAIN AND SPINE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1780247734
Entity Type Code : Organization
Provider Name (Legal Business Name) : VOLUSIA BRAIN AND SPINE LLC
Provider Business Mailing Address
First Line : 233 OSCEOLA AVE
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32176-6638
Country : US
Telephone Number : 386-405-6100
Fax Number :
Provider Business Practice Location Address
First Line : 233 OSCEOLA AVE
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32176-6638
Country : US
Telephone Number : 386-405-6100
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CHRISTOPHER S KENT
Credential : MBR
Telephone Number : 386-405-6100
Provider Enumeration Date : 04/16/2019
Last Update Date : 04/18/2019

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Directions to “VOLUSIA BRAIN AND SPINE LLC ” Practice Location

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